Healthcare Delivery Systems

Improvement Project

Kaitlin, Jenna, Paige, Katelyn, Lauren

12-9-15

Overview of Patient Care Delivery System

Adult Intensive Care Unit at a hospital in
Tucson, AZ 32 beds; 3 wings: ICU 3N, ICU 3E,
ICU 3W
oNurse to patient ratio 1:2 or 1:1
Delivery of Care
oTotal Patient Care
oDifferentiated practice
Microsystem Target Area: Staff Focus
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Microsystem Model:
Leadership
Quantum Leadership
Team Leadership
Critical Care thinkers
oIntuitive, knowledgeable, assertive, and willing to take
action

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th Edition). Philadelphia, PA:
Lippincott Williams & Wilkins.

Microsystem Mode
Organizational Culture and Support
Organizational culture
othe ways of thinking, behaving, and believing of the
unit
overy efficient
oclose staff, family feel
Organizational Support
o larger organization facilitates work of the microsystem
o provides resources & information
o House supervisor oversees the entire hospital
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th Edition). Philadelphia, PA:
Lippincott Williams & Wilkins.
Nelson, E. C., Batalden, P. B., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care: Part 1. Learning from
highperforming front-line clinical units. Joint Commission Journal on Quality and Patient Safety, 28(9), 472-493.

Microsystem Model:
Patient Focus & Staff Focus
Patient Focus
oprimary focus is to meet all patient needs
oprimary focus on supporting the families
Staff Focus
o selective hiring
o high expectations
o continuous education
Nelson, E. C., Batalden, P. B., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002).
Microsystems in health care: Part 1. Learning from highperforming front-line clinical units. Joint Commission
Journal on Quality and Patient Safety, 28(9), 472-493.

Microsystem Model:
Interdependence of Care Team
How does the team of care providers function
within the microsystem?
o Trust
o Collaboration
o Willingness to help each other
o Appreciation/recognition/respect of each individual

How does the team support patient-centered

care?
o Patient needs
o Mission Statement
o Vision Statement
o Interdisciplinary rounding

Microsystem Model:
Use of Information and Healthcare Technology
How is information and healthcare
technology used to support the functioning
of the microsystem?
o Cerner
o Online MR access
o Practice evidence-based care
o Modern technology
ICU technology

Microsystem Model:
Process for Healthcare Delivery Improvement

What is the best process for healthcare delivery

improvement?

An atmosphere for learning and redesign

supported by:
o Continuous monitoring of care
o Use of benchmarking
o Frequent tests of change
o Staff empowerment

Nelson, E. C., Batalden, P. B., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care: Part 1. Learning from
highperforming front-line clinical units. Joint Commission Journal on Quality and Patient Safety, 28(9), 472-493.

Microsystem Model:
Staff Performance Patterns

Performance patterns focus on multiple areas

Outcomes are measured, data fed back into the
microsystem, and further changes are made
based on:
o Patient Outcome
o Avoidable Costs
o Streamlining delivery
o Data Feedback
o Positive Competition
o Performance Discussions
Nelson, E. C., Batalden, P. B., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care: Part 1. Learning
from highperforming front-line clinical units. Joint Commission Journal on Quality and Patient Safety, 28(9), 472-493.

Specific Aspect Targeted for Improvement

Staff focus
oICU nurses need to continue education
Equipment is specialized in the ICU
o The unit has the highest acuity patients with
advanced machinery
o Example: EKOS machine
(N. Patze, Personal Communication, November 11, 2015).

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Specific Aspect Targeted for Improvement

(cont.)
Educating ICU nurses
oNurses should be educated in a way that

increases confidence and understanding

oThere should be educational sessions
available for night nurses to complete during
their regularly scheduled breaks
(N. Patze, personal communication, November 11, 2015).

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Leading the Plan for Healthcare Delivery

Improvement
Research articles
o High-fidelity training exercises
o Night shift clinical nurse specialist
Promoting change: rational-empirical method
o Supported with research
o Little resistance expected
(Marquis & Huston, 2015; Boling & Hardin-Pierce, 2015; Becker,
2014).

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References

Becker, Dawn M. (2014). Implementing a night-shift clinical nurse

specialist. Clinical Nurse Specialist, 27(1), 26-30. doi:
10.1097/NUR.0b013e3182777029
Boling, B., & Hardin-Pierce, M. (2015).The effect of high-fidelity
simulation on knowledge and confidence in critical care training: An
integrative review. Nurse Education in Practice, doi:
10.1016/j.nepr.2015.10.004
Nelson, E. C., Batalden, P. B., Mohr, J. J., Godfrey, M. M.,
Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health
care: Part 1. Learning from highperforming front-line clinical units.
Joint Commission Journal on Quality and Patient Safety, 28(9),
472-493.
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and
management functions in nursing: Theory and application (8th
Edition). Philadelphia, PA: Lippincott Williams & Wilkins.
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